Healthcare Provider Details

I. General information

NPI: 1376368605
Provider Name (Legal Business Name): CARDIOLIFE STUDIES CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 02/05/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE ALEJANDRINO, CARR #838 KM 1 HM 8
GUAYNABO PR
00969
US

IV. Provider business mailing address

URB. HACIENDA REAL 299 CALLE LIRIO DE PAZ
CAROLINA, PR PR
00987
US

V. Phone/Fax

Practice location:
  • Phone: 787-671-3169
  • Fax:
Mailing address:
  • Phone: 939-366-0469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROLANDO BERGOLLA HERNANDEZ
Title or Position: PRESIDENT
Credential:
Phone: 939-366-0469